Surgical plate systems

ABSTRACT

Improved bone plate systems are described herein. In some instances, a bone plate system can include a base plate, at least one retainer plate, and at least one spacer. The at least one retainer plate is configured to reside on the base plate in a free floating manner and can receive at least one fastener to secure the retainer plate to the at least one spacer, thereby providing a plate system that attaches to a spacer. In other instances, a bone plate system can include a base plate having one or more push plates that can engage at least one spacer.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.14/664,291 filed on Mar. 20, 2015, which is incorporated in its entiretyherein.

FIELD OF THE INVENTION

The present application relates to improved surgical plate systems,particularly those used with the spine.

BACKGROUND OF THE INVENTION

Millions are affected by back and neck pain. Many patients can respondwell to non-surgical treatments. However, many others may turn tosurgical solutions to alleviate their pain. In some instances, the paincan be caused from a herniated disc. A disc herniates when some of thedisc's gel like center bulges or ruptures through the outer ring of thedisc and presses on nerve roots or the spinal cord. To alleviate thepain, a surgeon may perform a procedure called a discectomy and fusion,whereby the disc is removed and a replacement disc with bone graft isinserted therein. A plate can then be screwed into adjacent vertebralbones, thereby stabilizing the spine and facilitating fusion andhealing. There is a constant need for improved plate and plate systemsthat can be used in surgical procedures.

SUMMARY OF THE INVENTION

Embodiments of the present application include the following. In someembodiments, an implantable system comprises a first spacer, a secondspacer, and a plate system configured to engage the first spacer and thesecond spacer, wherein the plate system comprises: a base platecomprising an upper portion, a mid portion and a lower portion; a firstbridge positioned between the upper portion and the mid portion; asecond bridge positioned between the mid portion and the lower portion;a first retainer plate in engagement with the first bridge; and a secondretainer plate in engagement with the second bridge, wherein the firstretainer plate is configured to receive a first pair of fasteners forextending into the first spacer; wherein the second retainer plate isconfigured to receive a second pair of fasteners for extending into thesecond spacer.

In other embodiments, an implantable system comprises a first spacer; asecond spacer; a plate system attachable to the first spacer and thesecond spacer, wherein the plate system comprises: a base plate; a firstretainer plate in contact with the base plate, wherein the firstretainer plate is configured to receive at least one fastener thatextends into the first spacer; and a second retainer plate in contactwith the base plate, wherein the second retainer plate is configured toreceive at least one fastener that extends into the second spacer.

In other embodiments, an implantable system comprises: a first spacer; asecond spacer; a plate system attachable to the first spacer and thesecond spacer, wherein the plate system comprises: a base plate; a firstretainer plate configured to receive at least one fastener that extendsinto the first spacer; and a second retainer plate configured to receiveat least one fastener that extends into the second spacer.

BRIEF DESCRIPTION OF THE DRAWINGS

The application will be more readily understood with reference to theembodiments thereof illustrated in the attached figures, in which:

FIG. 1 is a top perspective view of an improved plate system including abase plate and one or more retainer plates in accordance with someembodiments;

FIGS. 2A and 2B are different views of the improved plate system in FIG.1 whereby a base plate is shown separated from a retainer plate;

FIGS. 3A and 3B are different views of the improved plate system in FIG.1, whereby a base plate is engaged with one or more retainer plates;

FIGS. 4A-4E are different views of a spacer in accordance with someembodiments;

FIG. 5 is a perspective view of one or more spacers inserted in betweenvertebrae in accordance with some embodiments;

FIGS. 6A and 6B are different views of a base plate overlying the one ormore spacers in FIG. 5 in accordance with some embodiments;

FIGS. 7A-7C are different views of the base plate and retainer platesoverlying the one or more spacers in FIG. 5 in accordance with someembodiments;

FIGS. 8A-8C are different views of the improved plate system andassociated spacers in a final construct in accordance with someembodiments;

FIGS. 9A and 9B are different views of an alternative improved platesystem including a base plate and one or more push plates in accordancewith some embodiments;

FIGS. 10A and 10B are different views of the improved plate system shownin FIGS. 9A and 9B in accordance with some embodiments;

FIGS. 11A and 11B are different views of an improved plate systemincluding push plates in a first configuration positioned over one ormore spacers in accordance with some embodiments;

FIGS. 12A and 12B are different views of the improved plate system shownin FIGS. 11A and 11B with the push plates pushed outwardly to thespacers in a second configuration in accordance with some embodiments;

FIGS. 13A and 13B are different views of the improved plate system shownin FIGS. 11A and 11B in a final construct in accordance with someembodiments;

FIG. 14 is a perspective view of yet another alternative improved platesystem including a base plate and one or more push plates actuated by adriver in accordance with some embodiments;

FIGS. 15A and 15B are different views of yet another alternativeimproved plate system including a translating boss in accordance withsome embodiments;

FIGS. 16A and 16B are different views of the improved plate system ofFIGS. 15A and 15B with fasteners inserted therein;

FIG. 17 is a perspective view of one or more spacers inserted in betweenvertebrae in accordance with some embodiments;

FIG. 18 is a perspective view of an improved plate system overlying thespacers in FIG. 17 with temporary screws placed therein in accordancewith some embodiments;

FIG. 19 is a perspective view of the improved plate system of FIG. 18positioned over spacers and an instrument with a driver in accordancewith some embodiments;

FIG. 20 is a view of the improved plate system of FIG. 18 in a finalconstruct in accordance with some embodiments.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

Embodiments of the application will now be described. The followingdetailed description of the application is not intended to beillustrative of all embodiments. In describing embodiments of thepresent application, specific terminology is employed for the sake ofclarity. However, the application is not intended to be limited to thespecific terminology so selected.

The present application is directed to improved plate systems, devicesand methods. The plate systems are used with spacers in fusionprocedures. As discussed further below, the plate systems provide anumber of advantages, such as providing less stress on spacers and thespine in general. While the improved plate systems, devices and methodscan be used in any part of the spine, including the lumbar and thoracicregions, the systems can be used particularly in the cervical region.

FIGS. 1-8C relate to embodiments of a plate system including one or moreretainer plates that can be operably attached or connected to animplanted spacer. In some surgical procedures, implanted spacers canmigrate within a disc space. The unintended migration of the spacerscauses stress to increase on both the spacer and the spine in general.The plate system embodiments shown in FIGS. 1-8C are designed toalleviate spacer migration by providing one or more retainer platescapable of attachment to one or more spacers, thereby fixing the one ormore spacers to the plate system and adjacent vertebral bodies.

FIG. 1 is a top perspective view of an improved plate system including abase plate and one or more retainer plates in accordance with someembodiments. In some embodiments, the one or more retainer plates 30 aand 30 b are capable of attaching to the base plate 20. The one or moreretainer plates 30 a and 30 b are advantageously capable of beingsecured to one or more spacers (as shown in FIGS. 7A-7C), therebyreducing the risk of spacer migration within the disc space.

In some embodiments, the plate system 10 comprises a base plate 20including an upper portion 20 a, a mid portion 20 b and a lower portion20 c. Each of the upper portion 20 a, mid portion 20 b and lower portion20 c of the base plate 20 comprise a first opening 22 and a secondopening 24 for receiving one or more fasteners. The one or morefasteners can include screws (either temporary or permanent) that areinserted into vertebral bone. While the present embodiment illustrates apair of openings 22, 24 on each of the portions 20 a, 20 b, 20 c of thebase plate 20, in other embodiments, each of the portions can include asingle elongated opening (either circular or elongated) or more than twoopenings for receiving additional screws for fixation into bone. In someembodiments, the upper portion 20 a of the base plate 20 can be attachedto a first vertebral body, the mid portion 20 b of the base plate 20 canbe attached to a second vertebral body, and the lower portion 20 c canbe attached to a third vertebral body. The upper portion 20 a can beconnected to the mid portion 20 b via a first bridge 25 a, while the midportion 20 b can be connected to the lower portion 20 c via a secondbridge 25 a.

Each of the upper portion 20 a, mid portion 20 b and lower portion 20 cof the base plate 20 includes rounded surfaces to advantageously reducedamage to surrounding tissue that abut the base plate 20. In someembodiments, each portion 20 a, 20 b and 20 c has completely edgelesssurfaces. In some embodiments, the upper portion 20 a, mid portion 20 band lower portion 20 c of the base plate 20 are flat, such that each oftheir upper surface is parallel to a lower surface. In otherembodiments, the upper portion 20 a, mid portion 20 b and lower portion20 c of the base plate 20 can be curved and possibly convexly shaped. Byhaving a curvature, each of the upper portion 20 a, mid portion 20 b andlower portion 20 c of the base plate 20 can easily conform to bone thatis positioned beneath the base plate 20.

As shown in FIG. 1, one or more retainer plates can reside over the baseplate in accordance with some embodiments. In some embodiments, a firstretainer plate 30 a is positioned over the first bridge 25 a between theupper portion 20 a and the mid portion 20 b of the base plate, while thesecond retainer plate 30 b is positioned over the second bridge 25 bbetween the mid portion 20 b and the lower portion 20 c of the baseplate. Each of the first retainer plate 30 a and the second retainerplate 30 b includes a first opening 32 and a second opening 34 forreceiving one or more fasteners. The one or more fasteners can includescrews (temporary or permanent) that are inserted into a spacer body.While the present embodiment illustrates a pair of openings 32, 34formed through each of the retainer plates 30 a, 30 b, in otherembodiments, each of the retainer plates can include a single elongatedopening (either circular or elongated) or more than two openings forreceiving additional screws for fixation into a spacer.

Each of the first retainer plate 30 a and the second retainer plate 30 bincludes rounded surfaces to advantageously reduce damage to surroundingtissue that abut the retainer plates. In some embodiments, each retainerplate 30 a, 30 b has completely edgeless surfaces. In some embodiments,the retainer plates 30 a, 30 b are flat, such that each of their uppersurface is parallel to a lower surface. In other embodiments, theretainer plates 30 a, 30 b can be curved and possibly convexly shaped.By having a curvature, each of the retainer plates 30 a, 30 b canconform to the underlying based plate 20, which may also have somecurvature. Furthermore, by having curvature, each of the retainer plates30 a, 30 b can be brought closer to a spacer to which they are attached.

In some embodiments, both the base plate 20 and the retainer plates 30a, 30 b can be formed of a metal. In some embodiments, the base plate 20is formed of a same metal as the retainer plates 30 a, 30 b. In otherembodiments, the base plate 20 is formed of a different metal as theretainer plates 30 a, 30 b. In some embodiments, at least one of thebase plate 20 and the retainer plates 30 a, 30 b is formed of titaniumor a titanium alloy. Other possible metals for use include vanadium,aluminum, steel, cobalt and their alloys.

FIGS. 2A and 2B are different views of the improved plate system in FIG.1 whereby a base plate is shown separated from a retainer plate. FIG. 2Aillustrates a top view of the retainer plate 30 b, while FIG. 2Billustrates a bottom view of the retainer plate 30 b.

The retainer plate 30 b is independent and separate from the base plate20. As shown in FIG. 2A, the base plate 20 can include an engagementfeature 27 positioned in the bridge 25 b in the form of a channel,opening or recess. In some embodiments, the engagement feature 27comprises a circular, oval or otherwise rounded channel. The engagementfeature 27 is designed to receive a bump out portion 37 (shown in FIG.2B) that extends from a bottom of the retainer plate 30 b. In someembodiments, the bump out portion 37 is similarly circular, oval orotherwise rounded, such that it can be easily received in the engagementfeature 27. Accordingly, the retainer plate 30 b easily engages the baseplate 20 via the bump out portion 37.

FIGS. 3A and 3B are different views of the improved plate system in FIG.1, whereby a base plate is engaged with one or more retainer plates. Insome embodiments, the plate 20 is engaged by at least two retainerplates 30 a and 30 b. The retainer plates 30 a, 30 b each include bumpout portions 37 (as shown in FIG. 2B) that are received in respectiveengagement features 27 positioned on the first bridge 25 a and thesecond bridge 25 b.

When the retainer plates 30 a, 30 b are engaged with the base 20, theretainer plates 30 a, 30 b remain generally free floating with the base20 such that they can still have dynamic motion relative to the base 20.This dynamic motion is allowed by the interface between the bump out 37of the retainer plates 30 a, 30 b and the engagement features 27 of thebase 20, which can all be for example, spherical. As shown in FIG. 3A,the retainer plate 30 b can be slightly angled, such that it can beoffset from an axis that is perpendicular to the longitudinal axis ofthe base 20. The advantage of having the retainer plates 30 a, 30 bmaintain dynamic motion relative to the base 20 is that the retainerplates 30 a, 30 b can be placed at any number of angles that allows themto more easily attach to particular spacers that could be orienteddifferently in the body.

In some embodiments, the retainer plates 30 a, 30 b remain free floatingwith respect to the base 20 such that they can be easily removed fromthe retainer plates 30 a, 30 b. In the free floating configuration, theretainer plates 30 a, 30 b have little if any securing to the base 20.In some embodiments, the retainer plates 30 a, 30 b remain free floatingrelative to the base 20 until the retainer plates 30 a, 30 b are securedto corresponding spacers. In other embodiments, the retainer plates 30a, 30 b can be attached to the base 20. For example, in someembodiments, the engagement between the retainer plates 30 a, 30 b andthe base 20 can be a friction fit, such as a snap fit, that secures thedifferent components together. Even under these circumstances, theretainer plates 30 a, 30 b may be capable of dynamic motion relative tothe base 20, based on the shape of corresponding bump outs 37 andengagement features 27.

FIGS. 4A-4E are different views of a spacer for use with a plate systemin accordance with some embodiments. The spacer 50 comprises an uppersurface 52 for engaging an upper vertebral body and a lower surface 54for engaging a lower vertebral body. Each of the upper surface 52 andthe lower surface 54 comprise protrusions, teeth or ribbing that help toengage bone. An opening 53 extends from the upper surface 52 to thelower surface 54 of the spacer 50. The opening 53 is configured toreceive graft material therein. In some embodiments, the spacer 50 canbe packed with graft material before being inserted into a disc space.In other embodiments, the spacer 50 can be packed with graft materialafter being inserted into a disc space.

The spacer 50 comprises a leading end and a trailing end. As shown inFIG. 4B, in some embodiments, the leading end can be chamfered ortapered to assist in distraction of bone. FIG. 4C shows a view of thetrailing end of the spacer 50. From this view, one can see a first screwopening 56, a second screw opening 58 and a tool opening 57 positionedtherebetween. The first screw opening 56 is configured to receive afirst fastener 62, while the second screw opening 58 is configured toreceive a second fastener 64 (as shown in FIG. 4E). In some embodiments,the first fastener 62 is configured to extend initially through a firstopening 22 in a retainer plate before passing through the first screwopening 56 in the spacer 50, thereby helping to secure the plate 10 tothe spacer 50. Likewise, the second fastener 64 is configured to extendinitially through a second opening 24 in a retainer plate before passingthrough the second screw opening 58 in the spacer 50, thereby helping tosecure the plate system 10 to the spacer 50. In other embodiments, thefasteners 62, 64 need not extend through the plate system 10, and needonly extend through the spacer 50.

Adjacent the first screw opening 56 and the second screw opening 58 is atool opening 57. In some embodiments, the tool opening 57 is threaded.The tool opening 57 can be configured to receive an insertion tool thatis correspondingly threaded. The insertion tool can be used to deliverthe spacer 50 to a surgical site prior to attaching the plate system 10to the spacer 50.

In some embodiments, the spacer 50 is made at least in part of a naturalmaterial, such as allograft bone. In other embodiments, the spacer 50 ismade at least in part of a non-natural material, such as PEEK. In someembodiments, the spacer 50 is sized and shaped to fit within a cervicaldisc space. In other embodiments, the spacer 50 is sized and shaped tofit within a thoracic or lumbar disc space.

FIGS. 5-8B show different views of a plate system 10 being used inconjunction with a pair of spacers 50 a, 50 b. In some embodiments, oneor more methods can be performed in accordance with these figures, aswill be discussed below.

FIG. 5 is a perspective view of one or more spacers inserted in betweenvertebrae in accordance with some embodiments. The first spacer 50 a ispositioned between a first vertebra 2 and a second vertebra 4, while thesecond spacer 50 b is positioned between the second vertebra 4 and athird vertebra 6. As shown in FIG. 5, the trailing ends of the spacers50 a, 50 b are exposed such that they are capable of receiving first andsecond screws through first screw opening 52 and second screw opening54. Each of the spacers can be implanted via an insertion tool that isinserted through tool opening 57.

FIGS. 6A and 6B are different views of a base plate overlying the one ormore spacers in FIG. 5 in accordance with some embodiments. The platesystem 10 includes a base plate 20 having an upper portion 20 a, a midportion 20 b and a lower portion 20 c. Retainer plates have not yet beenpositioned above the base plate 20. Once the base plate 20 is deliveredto the surgical site, the base plate 20 can be initially positionedrelative to the spacers 50 a, 50 b. In some embodiments, a temporaryfastener 42 (as shown in FIG. 7A) can be delivered to hold down the baseplate 20. In some embodiments, the temporary fastener 42 can comprise ascrew, nail or spike having a head portion and a shaft portion that iseasily delivered and easily removed from bone. In some embodiments, thetemporary fastener 42 can be a single spike. The use of the temporaryfastener 42 is optional.

FIGS. 7A-7C are different views of the base plate and retainer platesoverlying the one or more spacers in FIG. 5 in accordance with someembodiments. After the base plate 20 is positioned over the spacers 50a, 50 b, one or more retainer plates 30 a, 30 b can be positioned overthe base plate 20, as shown in FIG. 7A. The retainer plates 30 a, 30 bare each configured with holes or openings 32, 34 for receivingfasteners 44 therein. In some embodiments, the fasteners 44 comprisethreaded screws having a head portion and a threaded shaft portion. Insome embodiments, the fasteners 44 can be polyaxial. Once the retainerplates 30 a, 30 b are positioned over the base plate 20, the retainerplates 30 a, 30 b can be dynamically adjusted and angled. Fasteners 44can then be received through the openings 32, 34 of the retainer plates30 a, 30 b and into corresponding openings 56, 58 in a correspondingspacer 50 a, 50 b, thereby securing the retainer plates 20 a, 20 b (andthus the overall plate system 10) to the spacers 50 a, 50 b.Advantageously, when the retainer plates 30 a, 30 b are seated, theplates dynamically auto-correct into their final position as thefasteners 44 are inserted therein. By securing the plate system 10 tothe one or more spacers 50 a, 50 b, this advantageously preventsinadvertent migration of the spacers, and also reduces the stress on thespacers and vertebrae. With the fasteners 44 positioned through theretainer plates 30 a, 30 b and into the spacers 50 a, 50 b, any optionaltemporary fasteners 42 can be removed.

FIGS. 8A-8C are different views of the improved plate system 10 andassociated spacers 50 a, 50 b in a final construct in accordance withsome embodiments. With the temporary fasteners 42 removed from the baseplate 20, non-temporary fasteners 48 can be inserted therein to securethe base plate 20 to adjacent vertebrae. In some embodiments, thefasteners 48 comprise screws having a head portion and a threaded shaftportion. In some embodiments, the fasteners 48 are polyaxial. Once thefasteners 48 are inserted into bone members, a final construct (as shownin FIGS. 8A-8C) is created. In some embodiments, the final constructcomprises a base plate 20 attached to a first vertebra, a secondvertebra and a third vertebra via fasteners 48; a first retainer plate30 a attached a first spacer 50 a via fasteners 44; and a secondretainer plate 30 b attached to a second spacer 50 b via fasteners 44.In some embodiments, a shorter base plate 20 (e.g., one that spans thelength of two vertebrae) can be provided, while in other embodiments, alonger base plate 20 (e.g., one that spans the length of four or morevertebrae) can be provided. Likewise, in some embodiments, a singleretainer plate 30 can be provided (e.g., to attach to a single spacer),while in other embodiments, more than two retainer plates (e.g., toattach to three or more spacers) can be provided.

FIGS. 9A-20 relate to embodiments of a plate system including one ormore mechanisms that can be advanced to move (either by pushing orpulling) one or more spacers into a desirable location within a discspace. In some surgical procedures, implanted spacers may need to bepushed further into a disc space (e.g., more posteriorly). In order topush the spacers further, forceful tamping may need to be performed by asurgeon. Such forceful tamping may cause stress on both the vertebraeand on the spacers themselves (particularly on relatively fragilespacers comprised of allograft bone), that may result in inadvertentchipping and/or shearing of material within a patient. In some surgicalprocedures, implanted spacers may need to be brought closer to ananterior portion of the disc space, for which unnecessary force may alsobe used. The plate system embodiments shown in FIGS. 9A-20 are designedto alleviate the stress on the vertebrae and the spacers by providingmechanisms that provide controlled pushing or pulling of the spacerswithout the need for over forceful tamping.

FIGS. 9A and 9B are different views of an alternative improved platesystem including a base plate and one or more push plates in accordancewith some embodiments. The plate system 100 comprises a base plate 120including an upper portion 120 a, a mid portion 120 b, and a lowerportion 120 c. The upper portion 120 a includes a pair of holes oropenings 122, 124 for receiving one or more fasteners therein forengaging a first vertebral body. The mid portion 120 b includes a pairof holes or openings 126, 128 for receiving one or more fastenerstherein for engaging a second vertebral body. The lower portion 120 cincludes a pair of holes or openings 130, 132 for receiving one or morefasteners therein for engaging a third vertebral body. A first bridgeportion 125 a is positioned between the upper portion 120 a and the midportion 120 b, while a second bridge portion 125 b is positioned betweenthe mid portion 120 b and the lower portion 125 c. In some embodiments,the upper portion 120 a, mid portion 120 b and lower portion 120 c aresubstantially flat such that an upper face is substantially orcompletely parallel to a lower face of the plate. In other embodiments,the upper portion 120 a, mid portion 120 b and lower portion 120 c areat least partially curved. As shown in FIGS. 9A and 9B, in someembodiments, the entire perimeter of the base plate 120 can be curvedand rounded without any edges. In other embodiments, only portions ofthe base plate 120 are curved and rounded without any edges.

As shown in FIGS. 9A and 9B, a pair of push plates 134, 136 areconfigured to be attached to the base plate 120. A first push plate 134is operably attached to the first bridge portion 125 a of the base plate120. In some embodiments, the first push plate 134 can be threadinglyreceived in a first threaded opening 129 a formed in the first bridgeportion 125 a. Likewise, a second push plate 136 is operably attached tothe second bridge portion 125 b of the base plate 120. In someembodiments, the second push plate 136 can be threadingly received in asecond threaded opening 129 b formed in the second bridge portion 125 b.

Each of the push plates 134, 136 are configured to have a contactsurface for contacting a spacer body. First push plate 134 comprises afirst contact surface 150, while second push plate 136 comprises asecond contact surface 160. In some embodiments, the contact surfaces150, 160 are flat. In other embodiments, the contact surfaces 150, 160are curved. The contact surfaces 150, 160 are each designed to push intoa corresponding spacer within a disc space, thereby moving the spacerinto a more desirable position within the disc space. Furthermore, firstpush plate 134 comprises a first threaded post 154 surrounded byadjacent non-threaded posts 152, while second push plate 136 comprises afirst threaded post 164 surrounded by adjacent non-threaded posts 162(as shown in FIG. 10B). These features will be discussed further below.

In FIGS. 9A and 9B, the push plates 134, 136 are each in a firstconfiguration whereby they reside adjacent or near the base plate 120.Upon actuation by an actuator (as shown in FIG. 10A), the push plates134, 136 will be pushed outwardly away from the base plate 120 and intoa second configuration (as shown in FIG. 10B). This allows the firstcontact surface 150 to controllably push on a first spacer and thesecond contact surface 160 to controllably push on a second spacer,thereby reducing the need to use forceful tamping on the spacers.

FIGS. 10A and 10B are different views of the improved plate system inFIGS. 9A and 9B with the push plates pushed outwardly from the baseplate in accordance with some embodiments. As shown in FIG. 10A, each ofthe openings 129 a, 129 b are configured to receive an actuation membertherein. First opening 129 a is configured to receive first actuationmember 144, while second opening 129 b is configured to receive secondactuation member 146. In some embodiments, the actuation members 144,146 each comprise threaded actuating screws.

Rotation of the first actuation member 144 causes rotation of the firstthreaded post 154, thereby causing the first push plate 134 to extendoutwardly away from the base plate 120. Likewise, rotation of the secondactuation member 146 causes rotation of the second threaded post 164,thereby causing the second push plate 136 to extend outwardly away fromthe base plate 120. Advantageously, the actuation members 144, 146 eachprovide for controlled actuation of the push plates 134, 136, which inturn cause for controlled movement (e.g., translation) of correspondingspacers within their disc spaces.

FIGS. 11A-13B show different views of a plate system 100 being used inconjunction with a pair of spacers 50 a, 50 b. In some embodiments, oneor more methods can be performed in accordance with these figures, aswill be discussed below.

FIGS. 11A and 11B are different views of an improved plate systemincluding push plates in a first configuration positioned over one ormore spacers in accordance with some embodiments. As in FIG. 5, a pairof spacers 50 a and 50 b can be positioned between vertebrae. As shownin FIGS. 11A and 11B, a base plate 100 can be positioned on one or morevertebrae to reside over or overlay the spacers 50 a, 50 b. Optionally,one or more temporary fasteners (e.g., fixation screws) 164 can beinserted into the base plate 100 to maintain the base plate 100 in adesired orientation and position relative to the vertebrae beforeinserting non-temporary fasteners therein. The temporary fasteners cancomprise a head portion and a threaded shaft portion, and can be in theform of a screw, nail or spike.

As shown in FIGS. 11A and 11B, first push plate 134 resides over thefirst spacer 50 a, while second push plate 136 resides over the secondspacer 50 b. First push plate 134 can be actuated by actuation member144, while second push plate 136 can be actuated by actuation member146. In FIGS. 11A and 11B, the push plates 134, 136 are in a firstconfiguration whereby they reside adjacent or closer to the base plate120. In particular, FIG. 11B shows how actuation members 144, 146 haveroom to be downwardly threaded, such that the push plates 134, 136 canbe pushed outwardly onto their corresponding spacers 50 a, 50 b.

FIGS. 12A and 12B are different views of the improved plate system shownin FIGS. 11A and 11B with the push plates pushed outwardly to thespacers in a second configuration in accordance with some embodiments.In these figures, first actuation member 144 has been rotated such thatthe first push plate 134 is pushed outwardly from the base plate 120into a second configuration, whereby it pushes into spacer 50 a.Likewise, second actuation member 146 has been rotated such that secondpush plate 136 is pushed outwardly from the base plate 120 into a secondconfiguration, whereby it pushes into spacer 50 b. One skilled in theart will appreciate that the first push plate 134 need not be pushed thesame distance as the second push plate 136, and in some embodiments, onepush plate can be pushed outwardly while the other push plate remainscloser to the base plate. In FIGS. 12A and 12B, however, both pushplates 134, 136 are advantageously pushed outwardly such that they pushtheir spacers 50 a, 50 b into a more desirable posterior location in acontrolled fashion.

Once the spacers 50 a, 50 b have been pushed into a desired position,the push plates 134, 136 can each be returned to a position closer totheir first configurations. In other words, each of the push plates 134,136 can be brought closer to the base plate 120 via reverse rotation. Atthis point, the actuation members 144, 146 can be removed from the baseplate 120 if desired. Furthermore, any temporary fasteners can also beremoved and replaced with non-temporary or permanent fasteners.

FIGS. 13A and 13B are different views of the improved plate system shownin FIGS. 11A and 11B in a final construct in accordance with someembodiments. In the final construct, non-temporary or permanentfasteners 170 have been inserted into the base plate 120 and into bonemembers. In the final construct, the upper portion 120 a of the baseplate 120 is attached to a first vertebral body, while the mid portion120 b is attached to a second vertebral body and the lower portion 120 cis attached to a third vertebral body. As shown in FIG. 13A, theactuation members 144, 146 have been removed in the final construct. Inother embodiments, the actuation members 144, 146 can be kept within thebase plate 120 if desired. The base plate 120 advantageously providesstability as part of a spinal fusion procedure.

FIG. 14 is a perspective view of yet another alternative improved platesystem including a base plate and one or more push plates actuated by adriver in accordance with some embodiments. Like the bone plate in FIG.10A, the bone plate 200 comprises a base plate 220 including an upperportion 220 a, a mid portion 220 b and a lower portion 220 c. The upperportion 220 a comprises a pair of openings 222, 224 for receiving one ormore fasteners therethrough for insertion into a first vertebra. The midportion 220 b comprises a pair of openings 226, 228 for receiving one ormore fasteners therethrough for insertion into a second vertebra. Thelower portion 220 c comprises a pair of openings 230, 232 for receivingone or more fasteners therethrough for insertion into a third vertebra.The fasteners that are received in the openings can be temporaryfasteners 262 (as shown in FIG. 14), or permanent. Furthermore, like thebone plate in FIG. 10A, the bone plate 200 includes a first push plate234 and a second push plate 236 for advantageously pushing spacers intoa more desirable position (e.g., more posteriorly) within theirrespective disc spaces.

In contrast to the embodiment in FIG. 10A which uses actuation members144, 146 to actuate the push plates 234, 236, in the present embodiment,an instrument including a threaded driver can be used to actuate thepush plates 234, 236. The instrument 270 can comprise an elongated shaft280 having a distal threaded driver 282 attached thereto. In someembodiments, one or more instruments having a distal threaded driver 282can be downwardly threaded into openings 229 a, 229 b formed in the baseplate 220. Opening 229 a is formed in bridge 225 a, while opening 229 bis formed in bridge 225 b. As the distal threaded driver 282 isdownwardly threaded into an opening 229 a, 229 b, the driver actuates apush plate 234, 236, thereby causing the push plate 234, 236 to pushoutwardly and into a spacer. This advantageously provides a controlledmeans to force a spacer into a more desirable (e.g., posterior)location, without the need for forceful tamping. Once one or more of thepush plates 234, 236 have been used to push one or more spacers into adesired position, the distal threaded driver 282 can be reverse rotated,and the instrument 270 can be removed.

FIGS. 15A and 15B are different views of yet another alternativeimproved plate system including a translating boss in accordance withsome embodiments. As in the prior embodiments in FIGS. 10A and 14, theplate system 300 provides one or more mechanisms for controllably movingone or more spacers into a desired position within a disc space.Advantageously, the one or more mechanisms include a translatablecarriage or boss feature 352, 356 that receive a driver or screw 362,366 (shown in FIGS. 16A and 16B) therein. By being translatable, asurgeon can move the boss 352, 356 such that it is over any portion of aspacer, thereby providing more options from which to move a spacerwithin a disc space.

The plate system 300 comprises a base plate 320 having a top portion 320a, a mid portion 320 b and a lower portion 320 c. The top portion 320 aincludes a pair of openings 322, 324 for receiving one or more fastenerstherein for inserting into a first vertebra. The mid portion 320 bincludes a pair of openings 326, 328 for receiving one or more fastenerstherein for inserting into a second vertebra. The lower portion 320 cincludes a pair of openings 330, 332 for receiving one or more fastenerstherein for inserting into a third vertebra.

As shown in FIGS. 15A and 15B, the base plate 320 includes a firstelongated opening 342 and a second elongated opening 346. The firstelongated opening 342 is formed between the pair of openings 322, 324 inthe top portion 320 a and the pair of openings 326, 328 in the midportion 320 b of the base plate 320. The second elongated opening 346 isformed between the pair of openings 326, 328 in the mid portion 320 band the pair of openings 330, 332 in the lower portion 320 c of the baseplate 320. Each of the elongated openings 342, 346 is designed toreceive a translatable carriage or boss 352, 356 therein. In someembodiments, each of the elongated openings 342, 346 comprises a trackformed therein for receiving a translatable boss. In some embodiments,the track can be comprised of a recess (e.g., an inner recess forreceiving a boss therein or an upper recess for which a boss can resideon top of). Advantageously, the first boss 352 is capable of translatingalong the first elongated opening 342 and the second boss 356 is capableof translating along the second elongated opening 346. By providingtranslation, the bosses 352, 356 are capable of being more accuratelyplaced over corresponding spacers. Screws 352, 356 (shown in FIGS. 16Aand 16B) placed through the bosses 352, 356 and into underlying spacerscan be used to pull the spacers more anteriorly if desired in accordancewith some embodiments.

FIGS. 16A and 16B are different views of the improved plate system ofFIGS. 15A and 15B with fasteners inserted therein. FIG. 16A shows a topperspective view of the plate system 300, while FIG. 16B shows a bottomperspective view of the plate system 300. In some embodiments, thetranslatable bosses 352, 356 can receive fasteners 362, 366therethrough. In some embodiments, the fasteners 362, 366 can comprisescrews (e.g., polyaxial screws) having a head portion and a threadedshaft portion. In the top view of FIG. 16A, the head portion of thescrews 362, 366 are visible, while in the bottom view of FIG. 16B, thethreaded shaft portion of the screws 362, 366 are visible. The threadedshaft portions of the screws 362, 366 are designed to engage spacerbodies, as shown in FIG. 20. In some embodiments, rotation of the screws362, 366 results in the one or more spacers being brought closer to thebase plate 300.

FIGS. 17-20 show different views of a plate system 300 being used inconjunction with a pair of spacers 50 a, 50 b. In some embodiments, oneor more methods can be performed in accordance with these figures, aswill be discussed below.

FIG. 17 is a perspective view of one or more spacers inserted in betweenvertebrae in accordance with some embodiments. The first spacer 50 a ispositioned between a first vertebra 2 and a second vertebra 4, while thesecond spacer 50 b is positioned between the second vertebra 4 and athird vertebra 6. As shown in FIG. 17, the trailing ends of the spacers50 a, 50 b are exposed such that they are capable of receiving first andsecond screws through first screw opening 52 and second screw opening54. Each of the spacers can be implanted via an insertion tool that isinserted through tool opening 57.

FIG. 18 is a perspective view of an improved plate system overlying thespacers in FIG. 17 with temporary screws placed therein in accordancewith some embodiments. The plate system 300 comprises a base plate 320having an upper portion with openings 322, 324, a mid portion withopenings 326, 328 and a lower portion with openings 330, 332. Fasteners,such as temporary fasteners 364, can be delivered through one or more ofthese openings and into bone, thereby holding the base plate 320 inplace. As shown in FIG. 18, a first temporary fastener 364 is deliveredinto the first vertebra 2, while a second temporary fastener 364 isdelivered into the third vertebra 6. At this point, translatable bosses352, 356 that are received within elongated slots 342, 346 of the baseplate 320 can be translated. Once the bosses 352, 356 are placed in adesired position above the spacers 50 a, 50 b, the plate system 300 isready to receive one or more screws through the translatable bosses andinto the spacers.

FIG. 19 is a perspective view of the improved plate system of FIG. 18overlying spacers and an instrument with a driver in accordance withsome embodiments. The instrument comprises an elongated shaft 380 and athreaded distal driver 382. The driver 382 is capable of driving firstscrew 362 and second screw 366 into engagement with the spacers 50 a, 50b. As the driver 382 is rotated, each of the spacers 50 a, 50 b can bepulled upward toward the base plate 320, until the base plate 320 isadjacent or in close abutment with the base plate 320.

FIG. 20 is a view of the improved plate system of FIG. 18 in a finalconstruct in accordance with some embodiments. As shown in this figure,each of the spacers 50 a, 50 b have been brought close to the base plate320.

While the application herein disclosed has been described by means ofspecific embodiments and applications thereof, numerous modificationsand variations can be made thereto by those skilled in the art withoutdeparting from the scope of the invention. It should be understood thatvariations and modifications within the spirit and scope of theinvention might occur to those skilled in the art to which the inventionpertains. Accordingly, all expedient modifications readily attainable byone versed in the art from the disclosure set forth herein that arewithin the scope and spirit of the present invention are to be includedas further embodiments of the present invention.

What is claimed is:
 1. An implantable system comprising: a plate systemcomprising: a base plate having at least four through holes forreceiving bone fasteners to engage with bone and a slot positionedbetween an upper and lower portion of the base plate; a translatablecarriage positioned within the slot of the base plate, the translatablecarriage configured to receive a fastener, wherein the fastener is apolyaxial screw having a head and a shaft, wherein the slot is anelongated opening and the translatable carriage comprises a perimeterconfigured to fit and move within the elongated opening; and a spacerconfigured to be positioned between adjacent vertebral bodies and havinga first opening for receiving the fastener, wherein the translatablecarriage is configured to translate within the slot to align thefastener with the first opening in the spacer, and wherein the firstopening is configured and dimensioned to receive at least a portion ofthe shaft of the fastener.
 2. The implantable system of claim 1, whereintwo of the at least four through holes are positioned on the upperportion of the base plate.
 3. The implantable system of claim 1, whereintwo of the at least four through holes are positioned on the lowerportion of the base plate.
 4. The implantable system of claim 1, whereinthe slot is positioned between the two through holes of the upperportion and the two through holes of the lower portion of the baseplate.
 5. The implantable system of claim 1, wherein the slot comprisesa track for receiving the translatable carriage.
 6. The implantablesystem of claim 5, wherein the track comprises a recess.
 7. Theimplantable system of claim 1, wherein the first opening is threaded andthe shaft of the fastener is threaded and wherein the first openingthreadably receives the at least a portion of the shaft of the fastenerwherein the translatable carriage is configured to translate within theslot and to receive the fastener.
 8. The implantable system of claim 7,wherein the rotation of the fastener causes the spacer to move towardsthe base plate.
 9. The implantable system of claim 1, wherein the spacerincludes a tool opening disposed between the first opening and a secondopening and configured to receive an insertion tool for implantation ofthe spacer.
 10. The implantable system of claim 9, wherein the toolopening is threaded.
 11. An implantable system comprising: a platesystem comprising: a base plate having at least six through holes forreceiving bone fasteners to engage with bone and a first slot and asecond slot positioned between an upper and lower portion of the baseplate; a first translatable carriage positioned within the first slotand a second translatable carriage positioned within the second slot,the first translatable carriage configured to receive a first fastenerand a second translatable carriage configured to receive a secondfastener, wherein the first and second fasteners are polyaxial screwseach having a head and a shaft, wherein the first slot is an elongatedopening and the first translatable carriage comprises a perimeterconfigured to fit and move within the elongated opening; a first spacerconfigured to be positioned between a first vertebral body and a secondvertebral body and having a first opening for receiving the shaft of thefirst fastener; and a second spacer configured to be positioned betweenthe second vertebral body and a third vertebral body and having a secondopening for receiving the second fastener for receiving the shaft of thesecond fastener, wherein the first translatable carriage is configuredto translate within the first slot to align the first fastener with thefirst opening in the first spacer, wherein the second translatablecarriage is configured to translate within the second slot to align thesecond fastener with the second opening in the second spacer, whereinthe first opening in the first spacer is configured and dimensioned toreceive at least a portion of the shaft of the first fastener, andwherein the second opening in the second spacer is configured anddimensioned to receive at least a portion of the shaft of the secondfastener.
 12. The implantable system of claim 11, wherein two of the atleast six through holes are positioned on the upper portion of the baseplate.
 13. The implantable system of claim 11, wherein two of the atleast six through holes are positioned on the lower portion of the baseplate.
 14. The implantable system of claim 11, wherein two of the atleast six through holes are positioned in a middle portion of the baseplate.
 15. The implantable system of claim 11, wherein the first slot ispositioned between the two through holes of the upper portion and thetwo through holes of the middle portion of the base plate.
 16. Theimplantable system of claim 11, wherein the first slot is positionedbetween the two through holes of the middle portion and the two throughholes of the lower portion of the base plate.
 17. The implantable systemof claim 11, wherein the first slot comprises tracks for receiving thefirst translatable carriage.
 18. The implantable system of claim 11,wherein rotation of the first and second fasteners causes the first andsecond spacers to move towards the base plate.